NPIMap

Organization Active NPI

Acworth Outpatient Detox, LLC

  • Substance Use Disorder Rehabilitation Clinic/Center
  • Acworth, GA
National Provider Identifier
1497327720
Registry record updated Jun 24, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Substance Use Disorder Rehabilitation Clinic/CenterTaxonomy code 261QR0405X
Legal business name
ACWORTH OUTPATIENT DETOX, LLC
Practice address
6060 Lake Acworth Dr NW Ste H
Acworth, GA 30101-7358
Phone
(229) 560-8634
NPI assigned
Jul 15, 2021
Organization subpart
No

Authorized official

NPPES NPI Registry
Name
Jonathan Denker
Title
Member
Phone
(229) 560-8634

Practitioners 14

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 14

National Provider Directory

National Provider Directory

Locations

6060 Lake Acworth Dr NW
Ste H
Acworth, GA 30101
Phone (770) 575-0679

Specialties & licenses 2

NPPES NPI Registry
Specialty (taxonomy)CodeLicenseStatePrimary
Substance Use Disorder Rehabilitation Clinic/Center 261QR0405X Primary
Recovery Care Clinic/Center 261QR0800X

Addresses

NPPES NPI Registry

Primary practice location

6060 Lake Acworth Dr NW Ste H
Acworth, GA 30101-7358

Mailing address

6060 Lake Acworth Dr NW Ste H
Acworth, GA 30101-7358

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Jun 24, 2022.

{
    "created_epoch": "1626307200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1656028800000",
    "number": "1497327720",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6060 LAKE ACWORTH DR NW STE H",
            "city": "ACWORTH",
            "state": "GA",
            "postal_code": "301017358"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6060 LAKE ACWORTH DR NW STE H",
            "city": "ACWORTH",
            "state": "GA",
            "postal_code": "301017358",
            "telephone_number": "229-560-8634"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ACWORTH OUTPATIENT DETOX, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-07-15",
        "last_updated": "2022-06-24",
        "certification_date": "2022-06-24",
        "status": "A",
        "authorized_official_last_name": "DENKER",
        "authorized_official_first_name": "JONATHAN",
        "authorized_official_title_or_position": "MEMBER",
        "authorized_official_telephone_number": "229-560-8634"
    },
    "taxonomies": [
        {
            "code": "261QR0405X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation, Substance Use Disorder",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261QR0800X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Recovery Care",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Acworth, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 24, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.